吻合血管的腓骨瓣移植一期重建双侧下颌骨

One-stage reconstruction of bilateral mandibular with free fibula flap

目的 探讨下颌骨巨大肿瘤截骨切除后应用游离腓骨复合组织瓣一期重建双侧下颌骨方法和疗效。方法 2 0 0 0年 7月至 2 0 0 2年 10月 ,分别对波及双侧下颌骨的 4例巨大成釉细胞瘤、2例牙龈癌施行截骨切除 ,手术造成跨中线的双侧下颌骨巨大缺损。根据下颌骨缺损的特点 ,以腓动静脉为血管蒂切取腓骨肌 (皮 )瓣 ,经截骨塑形后 ,用微形钛板将移植骨与双侧下颌骨残端坚固内固定 ,腓动、静脉与颈部小血管吻合 ,形成血管化腓骨复合组织瓣一期重建双侧下颌骨。结果 6例移植腓骨复合组织瓣全部成活。随访 6个月～ 2年 ,面下部外形恢复良好 ,移植腓骨与上颌骨相对位置正常 ,接受活动义齿修复后咬合关系和咀嚼功能均较满意。结论 腓骨复合组织瓣节段性的骨膜供血和骨髓滋养动脉的双重供血特点十分适合塑造成下颌骨的弓状形态 ,是修复下颌骨巨大肿瘤导致的跨中线双侧下颌骨巨大缺损的理想材料。

Objective To explore the method of clinical application and the efficacy of free fibula osteomyocutaneous flap in one-stage reconstruction of transmidline bilateral mandibular defect caused by giant neoplasms. Methods From july 2000 to october 2002, transmidline bilateral mandibular defects caused by ameloblastoma(4 cases) and gingiver carcinoma(2 cases), according to the character of defects, were reconstructed with free fibula osteomyocutaneous flaps. Peroneal artery and vein were used as vascular pedicle, the fibula was reshaped, and micro-titanium plates were used in rigid fixation between fibula and residue of bilateral mandible. Microvascular anastomoses were carried out between peroneal artery/vein and small artery/vein in neck. Results Six free fibular osteomyocutaneous flaps survived well. Follow up duration ranged from 6 months to 2 years, the lower face appearance recovered well, occlusion relationship were normal, all patients were satisfactory with appearance and chewing function after repair of removable denture. Conclusion Free fibular osteomyocutaneous flap is a favorable material in the reconstruction of transmidline bilateral mandibular giant defect. The blood supplement of fibula is offered both by segmentral periosteum and nutrient artery from bone marrow, It is greatly benefit to reshaping as arched mandible.